Permit f•
• - A - CITY OF T I G A R D SITE WORK PERMIT
k*ft DEVELOPMENT SERVICES PERMIT # : SIT2001 -00021
��' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 10/29/01
SITE ADDRESS: 08060 SW PFAFFLE ST PARCEL : 1S136CD-00600
SUBDIVISION: SPRINT PCS WIRELESS MONOPOLE ZONING : C -P
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: $209,660.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Remarks: Site work for new 20,400 sq. ft. office building.
Owner:
FEES
EEI SOLUTIONS
5665 SW MEADOWS RD, STE 300 Type By Date Amount Receipt
LAKE OSWEGO, OR 97035 PLCK CTR 9/20/01 $762.25 27200100000
FIRE CTR 9/20/01 $469.32 27200100000
Phone: 503 - 294 -2150 PRMT CTR 10/29/01 $1,173.30 27200100000
5PCT CTR 10/29/01 $93.86 27200100000
Contractor: EROS CTR 10/29/01 $100.00 27200100000
PANATTONI CONSTRUCTION CO. LLC ERPU CTR 10/29/01 $32.50 27200100000
ERPC CTR 10/29/01 $32.50 27200100000
1400 SW FIFTH AVE
SUITE 810 Total $2,663.73
PORTLAND, OR 97201
Phone:
Reg #: LIC 140755
Required Inspections
Erosion Control lnsp 846 -8444
Excavation
Fill
Grading
Sprinkler supply lines
Fire system test
Final Report Eng'd Grading
Final Inspection
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -1987.
Permittee Signature:
Issued By:' Air Li
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
.. /7" 0 ,02/c 6-z C
t . ili, . Building Permit Application
Date receivedq / n / Permit no jir,a110/-40,0 '
a ;,J �� City of Tigard Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 O
Phone: (503) 639 -4171 piZ J 700 / @ p K q 4. Date issued: By:. , Receipt no.:
Fax: (503) 598 -1960 1 Case file no.: Payment type:
1/92 07 00 /- D 0 i2/ 3
Land use approval: S J.� /e a00/- D00 /0 l &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory Commercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: •
JOB SITE INFORMATION
Job address: SOtot7 $ t PF .kFF - S r -Er Bldg. no.: Suite no.:
Lot: ( Block: Subdivision: ( Tax map /tax lot/account no.: 60a •,-, Project name: C4 pie? FLA ZA.- S /7-5" /...)02k. Fi2 •
..�
Z S Tt / h �G/- or- /5cx
Description and location of work on premises/special conditions: t.'6 ,
s
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST 7_
Name: e / o rto.)t (Floodplain, septic capacity, solar, etc.)
Mailing address: 5(7(75 51...) A- 16:tpa...* 2P, Sotf& 340 1 & 2 family dwelling: • C.
City: G,w u- ObC„K ,o (State:Of . (ZIP: 970,35" Valuation of work $
Phone: (Fax: (E-mail: No. of bedrooms/baths
Owner's representative: I :, gk. G.tMb(ZCwt) Total number of floors r
• Phone: 0:3ZS4 -Z /5o Fax: 297 4 /4 E -mail: New dwelling area (sq. ft.) ?Q
APPLICANT Garage/carport area (sq. ft.)
Name: MiGNA 3 :S — GAS Covered porch area (sq. ft.) CX,
Mailing address: / /Z( 6t.) _54/44r21-; .5t vie (D v Deck area (sq. ft.)
City: PorcTt..*M7 (State:O(? ( ZIP_ 9-7ZG,-- Other structure area (sq. ft.)
Phone: .503- z2! -l tzt Fax: 221-7417 E-mail: CommerciallindustriaUmulti- family: /0 ,P (70.0
CONTRACTOR Valuation of work .$X1.
Business name: PANArromi G�luynute.77 Co, LIZ
Existing bldg. area (sq. ft )
Address: / NOD 5 t..' F p� Ave, 6. vrFai • £J D New bldg. area (sq. ft.) Z0, N�
City: 'o Atr [State: are ( ZIP: /no/ Number of stories z
Phone:5o3.Z ?4 -4442( Fax: Z741-54b51 E -mail: Type of construction H
Occupancy group(s): Existing:
CCB no.: I t-1 O I S S
New: 13
City /metro lic. no.: Notices All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: G /ZS , 00-I % /NC. provisions of ORS 701 and may be required to be licensed in the
Address: // Z ( 5 t....) SfrLnO� 5 r, s wire /0 jurisdiction where work is being performed. If the applicant is
City: 7 TZTl,#tHP I State: CM ( ZIP: 9 7205 exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: 573- Z2l -Ir2I Fax: 6o3.2Z1- E -mail:
ENGINEER
Name: V i--t K. Contact person:51K KoAS4 Fees due upon application $
Address: 3 3z, s%,.) Kee l.-`i o} Date received:
City: pocbrt -Dc W (State:Orl. (ZIP: q'7 Amount received $
Phone: 5€25-Z7.2..-449 ( Fax: Z4$ -5-743( E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Na all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All . lie •sions of la -s an, o . inances governing this ❑ Visa ❑ MasterCard
work will be compli . wi • • . ' .. herein or not. Credit card number: / I
r 1- i� -o' Expires
Authorized signature: ,,/ Date: Name of cardholder as shown on credit card
Print name: CµAt L. SO $
Cardholder signature Amount
Notice: This permit application expires i ' a permit is not obtained within 180 days after it has been accepted as complete. 44oa6l3 (6.00/COM)
4 u/efLn/ T°' 3' 5
a -,I.
•
SITE WORK PERMIT CHECK LIST
Commercial and Multi - Family: Complete ENTIRE form.
Residential: Complete SHADED areas only.
Excavation Volume: cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) cu. yds. • •
Fill Volume: . •
(Fill exceeding 12" in depth shall be compacted to
• 90% of maximum density)
•
cu. yds.
Retaining structure? . (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other
•❑ .
•
Total new impervious area including all buildings,
sidewalks, and paving: sq. ft.
Site Utilities Plumbing Work:
Complete the "TAN" Plumbing Permit Application for site utilities plumbing work. •
Plans Required: See "Site Work Permit Application - Plan Submittal
Requirements" attached. The following must accompany this application:
Site Plan with Vicinity Map Parking (including ADA) and
showing ADA compliance Lighting Plan
Grading Plan and details Landscaping Plan .
Erosion Control Plan and details Retaining Structures .
Site Utility Plan and details Soils Report (if required)
(showing connection to approved
_ system)
•
•
•
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is \dsts \forms\sitechecklist.doc 12/21/00
CITY OF TIGARD 24 -Hour
BUILDING • Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST I _ '
BUP r d"3 7 j
5
Received Date Retie ted CP // 0 AM PM BUP
Location D 0 ( o 0 Suite MEC
Contact Person ��r l-cd Ph ( ) g s'e O PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
A ccess:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT f- d O 6 ,)- I
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
' Framing
Insulation
Drywall Nailing
Firewall f Fire Sprinkler fry � AIL — -
Fire Alarm 1)6 -e S 7-' - P re S 7--
Susp'd Ceiling J
Roof q �Q, J"'► . 1 ' L----- 6 /��. _
• • . r:
1 :0 , ; PART FAIL
- ING ` dy i C
Post & Beam
Under Slab 'r Vz Cc 1�c-c - c.f E . Ji ` 6- 7P) y) 1 Z s
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole D
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
r.---___ ��
Final `/ %� �
PASS PART FAIL G /
ELECTRICAL ,
Service J
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 11 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date U nspector Ext
of : DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL